Lifting a heavy object can result in the sensation of "throwing your back out." But so too can the simple act of bending over to tie your shoe.

© Antonio Guillem | Dreamstime.com

No one seems to know how the phrase “throwing your back out” originated, but almost everyone knows what it means: You’ve injured your back and it really hurts.

When you yell out “threw out my back!” you’ll know the pain immediately. There will be a sharp, severe pain, usually in your lower back, and it can be an on-the-floor, can’t-move, debilitating experience. You won’t care what “throwing your back out” means. You’ll just want pain relief—right now.

The underlying cause of pain that severe could be a complex medical condition such as a herniated disc, spinal stenosis, or sciatica, but more often it’s just a strained (pulled) muscle.

It might not sound as threatening as other back conditions, but in the short term, a muscle strain can be more painful than all of them. The pain itself is there because of a muscle spasm reacting to overload or overuse.

1. Strained (Pulled) Muscle

Back strains—tears in tendons or ligaments—occur after sudden or awkward movements, when lifting or moving a heavy object, or absorbing an unexpected blow. They might also develop when a person repetitively uses (or overuses) a muscle not accustomed to that particular activity.

Yet at times, back strains are triggered by seemingly harmless movements, such as bending over to tie a shoe, picking up an object, or reaching to get something out of a cabinet.

Strained Muscle Treatment:

• See a doctor immediately if severe pain spreads down one or both legs, causes weakness or numbness, or follows a fall or a blow to your back.
• Otherwise, rest your back for 24 to 48 hours, but don’t stay completely immobile.
• Limited, mild movement is better than bed rest.
• Apply ice packs for 15 to 20 minutes, three to four times a day for the first 48 to 72 hours.
• Apply moist heat after the first 48 to 72 hours if it makes you more comfortable.
• Aspirin, acetaminophen, ibuprofen, and naproxen may relieve pain.
• All except acetaminophen will reduce inflammation.
• If you sleep on your side, place a pillow between your knees. If you sleep on your back, place a pillow under your knees.

More than 90 percent of people with a lower back strain recover within a month, although that information won’t be reassuring if you’re the one having spasms.

2. Herniated Disc

Another possible cause of a “throwing your back out” is a herniated disc. The condition is not usually associated with a specific traumatic event, but rather by wear and tear on the spine.

Discs that become herniated usually are in an early stage of degeneration, according to the American Association of Neurological Surgeons. The spinal canal has limited space, which is inadequate for the spinal nerve and the displaced herniated disc fragment. Because there is not enough room for both, the disc presses on spinal nerves, often producing severe pain.

Anyone can develop a herniated disc, but older adults are especially susceptible. Prolonged sitting and repetitive lifting and twisting are also risk factors, as is reduced muscle tone caused by a lack of physical activity.

Herniated Disc Treatment:

• The initial treatment is rest, ice, and anti-inflammatory or pain medications. Apply ice for the first 48 to 72 hours, and then switch to moist heat. Mild activity is better than bed rest.
• Longer-term treatment includes physical therapy, non-steroidal anti-inflammatory medication, massage, an epidural steroid injection, or the use of TENS (transcutaneous electrical nerve stimulation) devices that send electrical impulses to prevent pain signals from reaching the brain. An epidural steroid injection is a way of delivering the steroid medications around the compressed or irritated nerve root, but its effectiveness has been challenged by several studies.

3. Bulging Disc

There is a difference between a herniated disc and a bulging disc.

A bulging disc is like having low air in a tire. Some of the cushion in the middle of the ring is lost, the disc collapses, and the fibrous ring bulges out.

A bulging disc is a normal phenomenon and generally does not cause symptoms unless it presses on nerve roots. Even if that happens, symptoms can usually be managed by waiting to see if your symptoms go away, pain medications, and physical therapy.

Many patients who initially have problems due to a bulging disc find that their symptoms completely resolve over several weeks or months. The key is finding a way to manage the discomfort while waiting for the symptoms to subside.

Other Possibilities

Osteoarthritis (OA) can affect the spinal discs and facet joints just as it can other joints of the body. In fact, the spinal column consists of 33 vertebrae, increasing the odds of a problem. Most of the time, it’s in the lower part of the spinal column where the body’s weight places a significant load.

In spinal stenosis, the spinal canal narrows. Seventy-five percent of the time stenosis occurs in the lower back, but it can also happen in the shoulder/neck region.

A narrowed spinal canal reduces the blood supply to the nerves, causing pain. Bending forward increases the size of the canal and relieves the symptoms. Standing or extending the back decreases the size of the spinal canal, which aggravates the symptoms.

How to Prevent Throwing Out Your Back

Some back conditions may not be preventable (osteoarthritis, sciatica, stenosis), but you can at least reduce the risk of “throwing your back out” (i.e., muscle strains, herniated discs, and bulging discs), limiting the damage. Here’s how.

• Avoid sitting in one position for long periods of time. Move around and stretch every 20 to 25 minutes.
• Slowly and carefully execute difficult movements required in daily activities before doing them in actual situations.
• Use a lower back support as a reminder to keep the pressure distributed evenly on the muscles of the lower back.
• When lifting heavy objects, keep your back as straight as possible and use your legs.
• Avoid slouching when sitting.
• Don’t increase exercise intensity, frequency, or duration, more than 10 percent a week.

This article was originally published in 2018. It is regularly updated.